Missed Claims Submission to United Healthcare Student Resources

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Team ID: 
944
College / Administrative Unit: 
Student Affairs
Date Started: 
October 2009
Objective: 
To identify claims not submitted to United Healthcare Student Resources (UHCSR) for student and non-student accounts and to identify the cause(s) due to change in processes. Claims not submitted and identified over one year from date of services (DOS) are not payable by UHCSR resulting in potential loss of income for University Health Services (UHS).
Desired Results: 

1-11-2010 The total number of charges reviewed were 5,866. The number that were not submitted that should have been submitted were 177. This results in a 97.0% accuracy of claims submission.
Based upon the data identified above, the following actions are being taken:
1) International Screening will no longer be put into the “insurance” field in Point’n’Click. A new process will be identified for Spring 2010 to be tested out in January and February 2010.
2) Student Health Insurance is now reviewing student accounts when international students are late in enrolling in health insurance to verify that all retroactive claims have been submitted.
3) UHS IT will run a monthly report to verify that all charges are being reviewed and submitted appropriately.
4) Financial Services has created a back-up process for lab bills requiring a hold on the billing in an attempt to reduce the missed lab charges. Also, Financial Services will look further at the lab charges to verify the reason for these charges being “missed.”
The data will be re-evaluated in Spring/Summer 2010.

Name: 
Nancy Lambert
Members:
  • Karen Kline, Co-Leader
  • Barbara Virgil, Co-Leader